Innovative Practices for Value-Based Payment Models in Healthcare

Practice Transformation Training to Support Practices in VBP models Alternative Visit Types in VBP Models Allyson Gottsman Practice Innovation Program at CU September 9, 2024

Understand that Value Based Payment (VBP) models can meet patient needs without a billable event, compensation comes from prospective payment and shared savings Learning Objectives: Alternative Visit Types Based on Patient Need Understand that access to care can be with team members, not just a provider Identify options for alternative visit types in VBP

To increase compensation: Improve health To increase compensation: Improve health outcomes and reduce costs outcomes and reduce costs In APM 2 increased revenue comes from shared savings Prospective payment is design to provide stable income to provide opportunity to delivery care differently VBP enables creativity of visit types from team members (that may, or may not, be billable ) Decisions are based on what does the patient Decisions are based on what does the patient need need to improve outcomes and reduce cost Offers opportunity beyond FFS box of one size fits all" - Office visit with a provider so old school VBP Goal: Improve patient outcomes and reduce costs

New way of thinking Visits Touches by the Team Leverage non-provider team members working at the top of their licensure More touches results in more access and builds trust - They call before going to ED - They want the team to be involved in all their healthcare decisions Trust in care team reduces costs Increased touches can be achieved with alternative visit types, with non- providers, that may or MAY NOT be billable.

Alternative Visits aka Touches Shared medical appointments (Group visits) Asynchronous messaging Portal, Text, Email Home visits can be both professional and non-licensed staff Community health workers LPNs Remote monitoring/telephone support Nurse visits Immunizations & BP checks Pharmacists medication management Care navigators: population health outreach prevention, chronic conditions, apt navigation Care Managers: self management support Case Manager Community Health workers eConsults Diabetes Educators, Dieticians

As Facilitators, Help Practice Start Small and Grow Help the practice focus basic QI principle Start small: pick one alternative visit type/team touch Choose a population that addresses a pain point. Examples include: Patients with chronic conditions with no visit in 12 months Patients with high ED utilization Patients with polypharmacy that are not filling prescriptions Patients not in control of BP, Lipids, A1c

Case Study 1: Discussion What type of alternative What type of alternative visits/ team touches might help in the following scenario? visits/ team touches might help in the following scenario? Population: Multiple chronic conditions with no visit in 12 months A 55-year-old patient with diabetes and hypertension and mild depression/anxiety hasn t been to the practice in 12 months.

Discussion: Discussion: What type of alternative What type of alternative visits/team member support might help visits/team member support might help in the following scenario? in the following scenario? Multiple medications, RX not being filled Case Study 2: Discussion 72 year old-female, widow, CVD, Diabetes, neuropathy, loneliness Multiple medications

Case Study 3: Discussion Discussion: Discussion: What type of alternative What type of alternative visits/ team member engagement might help in the team member engagement might help in the following scenario? following scenario? visits/ Population: multiple chronic conditions, not in control. 45 year old female, married, 4 children, working full time, BMI of 28, hypertension, newly diagnosed with Type 2 diabetes.

Suggested Learning Activity: Work with one practice to identify an opportunity to use the team for additional touches to improve outcomes and reduce costs We will discuss your experiences at Office Hours: Monday, September 16 September 16th that 2:30.

Resources if Practices Need Convincing: Excellent Webinar on the ROI of Effective Use of Teams NIH: Enabling System Functionalities of Primary Care Practices for Team Dynamics in Transformation to Team-Based Care: Advancing Team-Based Primary Care: The Importance and Challenges in 2023 Nurse visits in Primary Care Visit Types in Primary Care - Telehealth Shared Medical Appointments/Group Visits

Moving from: one size fits all, traditional office visit, to alternative touches by the team provides personalized, accessible and efficient care Key Takeaway: More touches, More revenue VBP models provide the opportunity to utilize the team to increase access and build trust, which improves outcomes and reduces cost , which is what generates revenue .

Questions/Discussion Allyson Gottsman Allyson.gottsman@cuanschutz.edu Allyson.gottsman@cuanschutz.edu 303 303- -915 915- -7701 7701 .